Postoperative Chest Pain and Shortness of Breath: Need for Caution | Patient Case Quiz

A 47-year-old male presented with a one-week history of chest pain and shortness of breath. He had a past medical history significant for hypertrophic obstructive cardiomyopathy treated with septal myectomy one month before presentation. He described sharp, non-radiating chest pain that increased with deep inspiration and was relieved by leaning forward. He had a pericardial friction rub and elevated jugular venous pressure (JVP).

An echocardiogram was ordered and showed a moderate pericardial effusion, diastolic septal bounce with right atrial (RA) tethering and transmitral Doppler respiratory variation >45%. Cardiac magnetic resonance imaging (CMRI) was ordered and showed interventricular septal bounce, localized pericardial effusion adjacent to the right ventricle, thickened pericardium at 7 mm and circumferential pericardial late gadolinium enhancement (LGE) (Figure 1). Right and left heart catheterization showed pressure equalization in all chambers with a deep right atrial y descent. This confirmed the diagnosis of constrictive pericarditis (CP). Additionally, elevated inflammatory markers and marked late gadolinium enhancement represent active inflammation.

Figure 1

Figure 1

Left Panel: Four-chamber cardiac magnetic resonance image (CMRI) showing circumferential pericardial effusion, more prominent anterior to the right ventricle (white arrow).
Right Panel: Mild pericardial thickening and diffuse circumferential late-gadolinium enhancement due to inflammation.

Which of the following statements describes the best next step in the management of this patient?

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